Doping with thyroid medication?

This article was originally posted by Ryan at the original HillRunner.com Blogs.

This Wall Street Journal article prompted a lot of discussion yesterday about whether or not our sport has a new doping problem in the form of thyroid medication.

It’s always tough when medication for a genuine medical condition can also be a performance enhancing medication, as some people think this thyroid medication could. As I began reading this, I instantly thought of the fact that asthma seems to stricken track and field athletes at higher rates than it occurs in the general population. Anti-doping agencies allow inhaled corticosteroids for athletes suffering asthma with a "Therapeutic Use Exception" (TUE), which basically means they are granted permission to use a normally prohibited drug due to a medical condition that requires the drug as a part of treatment. There is no doubt that some of the athletes do have asthma and need the corticosteroid. There is no doubt that others are skirting the rules in order to use a performance enhancing substance.

I get the sense that this is the next generation of that issue. As of now, the thyroid medications being used are NOT banned substances. However, should they be banned? Typically, the drug cheats are ahead of the curve in figuring out what works and what doesn’t. It would not surprise me at all if, in the near future, we discover that these drugs are in fact performance enhancing in otherwise healthy athletes.

The question is what happens when this occurs? There are certainly some athletes who truly have thyroid conditions and require the medication to function normally so I’m certain a TUE will exist for these drugs. It already appears elite athletes are suffering from these thyroid conditions at far higher rates than the general population. If this is found to be performance enhancing, what will be the requirement of proof that you need this? Will TUEs for thyroid conditions become popular?

One of my favorite sports science bloggers has already written about this and I generally agree with him. I think this should be a banned substance that is only allowed with a TUE. The concern would then become how to test for the need. The current "quick" test seems very questionable and sounds like it may turn up a lot of false positives. Steve Magness mentioned on Twitter that this test could be used as a preliminary test and there is a follow-up test that is available that, as I understand it, could determine whether abnormal hormone levels are due to a problem with thyroid function or are related to other non-medical factors, such as the hard training that all elite athletes perform. I think this follow-up test should be required in order to get the TUE.

This is a very sticky and still developing topic. Does anyone want to share their thoughts at this point?